Monday, March 31, 2008

In a response to publicity regarding her failure to disclose funding of her research on the use of CT scans for lung cancer screening and her failure to disclose potentially significant financial interests in General Electric, which stands to gain from adoption of CT screening, Dr. Claudia Henschke and her institution - the Weill Cornell Medical College - released a statement defending both of these disclosure failures.

As I discussed here on Friday, in an October 26, 2006 article in the New England Journal of Medicine, Dr. Claudia Henschke of Weill Cornell Medical College and a group of other investigators reported the results of a study of the use of low-dose spiral CT scans as a screening tool to detect lung cancer among asymptomatic individuals. The article reported that 85% of patients with lung cancer detected had stage I cancer and the estimated 10-year survival among these patients was 88%. The study concluded that: "Annual spiral CT screening can detect lung cancer that is curable" and that "such screening could prevent some 80% of deaths from lung cancer."

The paper listed its funding sources at the end, one of which was the Foundation for Lung Cancer: Early Detection, Prevention & Treatment.

The New England Journal of Medicine has a policy of not publishing any paper supported with funds from the tobacco industry. Not seeing any disclosure of funding from the industry, the Journal published the paper.

However, it turns out that the Foundation for Lung Cancer: Early Detection, Prevention, & Treatment "was, according to a New York Timesarticle, "underwritten almost entirely by $3.6 million in grants from the parent company of the Liggett Group, maker of Liggett Select, Eve, Grand Prix, Quest and Pyramid cigarette brands. The foundation got four grants from the Vector Group, Liggett's parent, from 2000 to 2003."

According to the New York Times article and a concurrent article in The Cancer Letter, the Journal of the American Medical Association was also deceived by the absence of disclosure of Dr. Henschke's tobacco funding and would never have published her paper had they known that Henschke received tobacco industry money for her CT screening research.

To make matters worse, the Times reported that Dr. Henschke "failed to disclose in articles and educational lectures a patent and 10 pending patents related to CT screening and follow-up." By virtue of these financial interests, Dr. Henschke stands to benefit personally (financially) if her recommendations for the widespread adoption of CT scan screening for lung cancer are adopted.

Moreover, the Cancer Letter reports that "medical journals and providers and accreditors of continuing medical education are investigating her failure to disclose patents and royalties from commercial sponsors, including GE Healthcare. As the leading manufacturer of CT scanners, GE stands to benefit from Henschke's campaign to screen asymptomatic former and current smokers."

I wrote Friday that if it is true that Dr. Henschke has a significant financial interest in GE Healthcare, such as royalties, consultant fees, or licensing payments, and that financial interest was present in October 2006, then she did fail to disclose that interest in her New England Journal article as that article states: "No potential conflict of interest relevant to this article was reported."

The Rest of the Story

Unfortunately, in the March 26 statement from Dr. Henschke and Weill Cornell Medical College, they defend both of these failures in disclosure and do not accept any responsibility for misconduct or apologize for this conduct.

Regarding the failure to disclose funding of the research by a tobacco company, the statement argues that: "The original $2.4 million pledge to the Foundation -- and the work funded by the Foundation at Weill Cornell -- was fully and publicly disclosed at the time through a press release, and was substantially covered in the lay media. It was discussed and disclosed in the academic community at conferences, which were widely attended by advocacy groups, agencies, and by investigators from around the world interested in lung cancer screening. It was also fully disclosed to other foundations and groups wishing to contribute funds to I-ELCAP."

Unfortunately, that is simply not enough. The funding by the tobacco industry needs to be disclosed in the article itself, and to the journal. It is not enough to expect that the journal editors will look up the Foundation for Lung Cancer on the internet and search newspaper articles to try to find out who the Foundation's donors are.

I do not believe that Dr. Henschke can hide behind the excuse that she disclosed funding from the Foundation for Lung Cancer: Early Detection, Prevention & Treatment, and so that she did indeed disclose her funding sources. The intent of disclosure of funding is to provide editors, reviewers, and the public with relevant information about the source of funding, not merely to provide the name of the foundations or entities set up to receive that funding. Thus, I view the failure to disclose her funding from Liggett as a significant violation of ethical standards of conduct.

This defense is inadequate and it is unfortunate that the researcher is not willing to take responsibility for this failure. In many ways, I find this defense to be a worse offense than the original disclosure failure. To make a mistake is human, and perfectly acceptable if you admit your mistake, apologize, and learn from it. But to deny that there was any mistake and to worm around, trying to convince the public that you have indeed disclosed the funding when you haven't, makes the original offense even worse.

Regarding the apparent failure to disclose income paid by General Electric to the researcher through her institution from an intellectual property interest (licensing of a patent or patents), the statement defends failure to disclose this financial interest by arguing that it is not a significant financial interest as defined by federal regulations: "Cornell Research Foundation, a subsidiary of Cornell University, licensed technology (some of which is now patented) related to detection and measurement of nodules developed by Henschke, Yankelevitz and others to GE. As is typical at many institutions, the royalties were distributed to Cornell, which, in turn, provided a share to the inventors under Cornell intellectual property policy, which is in line with the Bayh-Dole Act. NIH Conflict of Interest regulations currently do not require individual disclosure of royalties paid to them by the employer institutions (see 42 CFR 50.603 -- Definition of "Significant Financial Interest")."

There are two problems with this defense.

First, I believe it is a misinterpretation of federal policy. The exception for compensation received from an institution applies, I believe, to compensation paid by the institution. I do not believe that exception was meant to apply to compensation, such as royalties for a licensed patent, paid by a corporation to an investigator through an institution. If that were the case, then any researcher could get around this problem by simply having the checks made out to the institution, and then having the institution make out a check to the researcher. Clearly, this is a circumvention of the spirit of the policy. The fact that General Electric made out checks to Cornell, which were then distributed, in part to Dr. Henschke, does not in my opinion mean that she did not have a significant financial interest under federal regulations.

Second, and more importantly, the policy of medical journals is not that investigators have to report significant financial interests as defined by federal policy. The policy of journals is that investigators have to report all significant financial interests, as defined by the journal.

The New England Journal of Medicine defines a significant financial interest as "any financial arrangement they [investigators] may have with a company whose product is pertinent to the submitted manuscript or with a company making a competing product."

Furthermore, the Journal describes the financial disclosure statement that is required of investigators as follows: "The statement should describe the authors’ relationships with companies that make products relevant to the paper. The statement should specify the type of relationships (e.g., consulting, paid speaking, grant support, equity, patents) EACH author has with EACH company."

In its published policy on conflicts of interest, the Journal even specifies that "patent royalties" are to be included as signficant financial conflicts of interest.

It is very clear, according to the Journal's policy, that investigators are to disclose all financial interests in companies whose products are pertinent to the manuscript.

No exceptions are made for royalties received from the university related to intellectual property licensed to a corporation. Given the information reported in the statement by Dr. Henschke and Cornell and the policy of the New England Journal of Medicine, I see no way one can conclude that there was not a blatant violation of the Journal's financial disclosure policy (unless the financial arrangement was not present at the time the manuscript was submitted, which does not seem to be the case).

Again, this weak attempt to defend the failure to disclose the significant financial interest appears to be an even greater offense than the original failure.

Why can't they just admit that a mistake was made, correct it, apologize, and move on?

The original failures to disclose the tobacco industry funding of this research and the existence of significant financial conflicts of interest were bad enough. But the defense of these unethical actions is an even worse offense.

Friday, March 28, 2008

In an October 26, 2006 article in the New England Journal of Medicine, Dr. Claudia Henschke of Weill Cornell Medical College and a group of other investigators reported the results of a study of the use of low-dose spiral CT scans as a screening tool to detect lung cancer among asymptomatic individuals. The article reported that 85% of patients with lung cancer detected had stage I cancer and the estimated 10-year survival among these patients was 88%. The study concluded that: "Annual spiral CT screening can detect lung cancer that is curable" and that "such screening could prevent some 80% of deaths from lung cancer."

The paper listed its funding sources at the end, one of which was the Foundation for Lung Cancer: Early Detection, Prevention & Treatment.

The New England Journal of Medicine has a policy of not publishing any paper supported with funds from the tobacco industry. Not seeing any disclosure of funding from the industry, the Journal published the paper.

The Rest of the Story

The rest of the story is that the Foundation for Lung Cancer: Early Detection, Prevention, & Treatment "was, according to a New York Timesarticle, "underwritten almost entirely by $3.6 million in grants from the parent company of the Liggett Group, maker of Liggett Select, Eve, Grand Prix, Quest and Pyramid cigarette brands. The foundation got four grants from the Vector Group, Liggett's parent, from 2000 to 2003."

According to the New York Times article and a concurrent article in The Cancer Letter, the Journal of the American Medical Association was also deceived by the absence of disclosure of Dr. Henschke's tobacco funding and would never have published her paper had they known that Henschke received tobacco industry money for her CT screening research.

To make matters worse, the Times reported that Dr. Henschke "failed to disclose in articles and educational lectures a patent and 10 pending patents related to CT screening and follow-up." By virtue of these financial interests, Dr. Henschke stands to benefit personally (financially) if her recommendations for the widespread adoption of CT scan screening for lung cancer are adopted.

Moreover, the Cancer Letter reports that "medical journals and providers and accreditors of continuing medical education are investigating her failure to disclose patents and royalties from commercial sponsors, including GE Healthcare. As the leading manufacturer of CT scanners, GE stands to benefit from Henschke's campaign to screen asymptomatic former and current smokers."

If it is true that Dr. Henschke has a significant financial interest in GE Healthcare, such as royalties, consultant fees, or licensing payments, and that financial interest was present in October 2006, then she did fail to disclose that interest in her New England Journal article as that article states: "No potential conflict of interest relevant to this article was reported."

Commentary

I am not, in this post, criticizing Dr. Henschke for either accepting tobacco industry funding or for having financial interests relating to the use of CT screening for lung cancer. What I am being critical of is the failure to disclose the tobacco industry funding of her research and the potential conflicts of interest.

Most disturbing to me is her failure to disclose the tobacco industry funding of her research. Clearly, this failure to disclose led to the deception of editors at two major journals which published her work about the nature of the funding sources for her research. Neither was aware of her funding by the tobacco industry; thus, her failure to disclose was substantial.

I do not believe that Dr. Henschke can hide behind the excuse that she disclosed funding from the Foundation for Lung Cancer: Early Detection, Prevention & Treatment, and so that she did indeed disclose her funding sources. The intent of disclosure of funding is to provide editors, reviewers, and the public with relevant information about the source of funding, not merely to provide the name of the foundations or entities set up to receive that funding. Thus, I view the failure to disclose her funding from Liggett as a significant violation of ethical standards of conduct.

Unfortunately, the reputation and validity of this important research has been tainted by these events. It should lead the public to question the objectivity of the conclusions of the research. In fact, as I have argued in detail (before knowing that the work was tobacco-funded), I believe that the current evidence does not support the use of CT scans as a screening tool for lung cancer and that widespread adoption of this approach at this time would be a public health disaster.

I also believe that the conclusions of the research are biased and do not reflect an appropriate, broad-based perspective on the criteria that are necessary to be met before a screening tool is adopted on a population basis. While the ELCAP researchers have jumped to recommend CT screening be adopted (perhaps not surprising in light of the financial conflicts of interest disclosed in this week's articles), they have not sufficiently addressed the important concerns regarding the false positives that result from screening and the harm that might be done by invasively investigating harmless nodules. In addition, I do not feel that they have addressed the potential harm inherent in exposing millions of people to the substantial radiation doses associated with CT scans (most of whom would be exposed unnecessarily).

Spiral CT screening for lung cancer has not yet been shown to be an effective and appropriate screening tool. The specificity of the test is very low, and combined with a very low prevalence of lung cancer in the population, the positive predictive value of CT screening is dismally low. This means that the overwhelming majority of patients who have lung nodules detected on CT scan will not have lung cancer. But these patients will require follow-up monitoring, and some will even require further invasive procedures to obtain a definitive diagnosis. These procedures carry a morbidity and even a mortality risk themselves and a number of the diagnostic procedures will result in morbidity or possibly mortality unnecessarily (by which I mean morbidity or mortality in patients who do not have lung cancer).

Another important consideration is the anxiety that could be produced in a huge number of patients who have nodules detected on CT scan but who do not have lung cancer. The protocol calls on these patients to either have invasive diagnostic procedures, which can be physically damaging, or to simply wait for 3 months for a follow-up test, which can be psychologically damaging. Imagine the anxiety a patient would have if told that they have an abnormal nodule in their lung that could be cancerous and what the doctor wants them to do is sit around for 3 months and try not to think about it.

In the ELCAP study, 4186 patients were identified as having abnormal lung nodules at baseline CT screening. Of these patients, only 405 were found to have lung cancer. Thus, 3781 patients had false positive results. The positive predictive value of the test was therefore only 10%. This means that a positive test result (the finding of a lung nodule) only indicates lung cancer 10% of the time. Ninety percent of the time, the test is wrong. That's usually viewed as being unacceptable for a screening test.

In this case, having 90% of your patients with nodules worrying unnecessarily for 3 months hardly seems acceptable to me.

If there were some gold standard, definitive test that could be performed immediately following the baseline CT scan to determine whether or not a patient has lung cancer, then this initial screening test might be acceptable. But I find it quite troubling that patients are being told that they may have cancer - please come back in 3 months and we'll either tell you how much it's grown or we'll tell you never mind, false alarm.

Also concerning is the fact that in this study, 43 patients had some form of invasive or surgical procedure, presumably ranging from fine-needle aspiration to bronchoscopy to mediastinoscopy to open lung biopsy, but ended up having nothing wrong with them.

In other words, what I'm trying to say is that without a doubt, instituting such a screening procedure is guaranteed to cause harm to some patients. It is likely to cause psychological harm to many, and physical harm to a smaller, but not negligible number of people.

On the other hand, we cannot say with certainty that instituting this screening procedure will result in benefit because it has not yet been demonstrated definitively that spiral CT screening for lung cancer does save lives.

Thursday, March 27, 2008

According to an article on the KCBS radio station site and another article on the local CBS television station site, the city of Berkeley has approved an ordinance that extends its outdoor smoking ban to include essentially the entire business district of the city.

Previously, the ordinance prohibited smoking within 25 feet of the entrance to any building open to the public and on sidewalks along 16 major streets. Now, the ordinance bans smoking outdoors in all commercial zones and essentially means that smoking will not be allowed at all in the business sections of the city.

The Rest of the Story

While at first glance, it might appear that the city of Berkeley passed this ordinance to protect nonsmokers from secondhand smoke, it turns out that the ordinance is part of a larger measure entitled the "Public Commons for Everyone Initiative."

According to an article in the San Francisco Chronicle, this is an effort to crack down on "yelling, littering, camping, drunkenness, smoking, urinating and sex on sidewalks and in parks."

According to the article, the initiative "will provide more housing, benefits counseling and public toilets for the hundreds of homeless people in Berkeley. It also beefs up enforcement of laws against lying on the sidewalk and imposes a smoking ban in commercial areas. Under the plan, seniors or social workers would walk around monitoring street behavior and either direct homeless people to social services or call the police if necessary. "There are people on the streets that we as a society are collectively responsible for," said City Councilman Laurie Capitelli. "I think sometimes people need help fixing their lives, and we collectively have to help people do that." City staff began crafting the initiative earlier this year in response to regular complaints from visitors, merchants and residents that the city's public places were becoming increasingly inhospitable as a result of rowdy behavior."

In other words, Berkeley business owners just want to get homeless people out of the way so that they don't lose money because people are annoyed to see these homeless people and don't want to have to deal with them.

While this might seem understandable, though insensitive, it appears that public smoking has been lumped into this group of morally reprehensible behaviors, including public yelling, littering, camping, drunkenness, urinating, and sex.

I can understand why city officials would want to outlaw public yelling, public littering, public camping in certain areas, public drunkenness, public urination, and public sex. However, how in the world did public smoking get onto that list?

Regulating smoking in order to prevent substantial secondhand smoke exposure among nonsmokers is reasonable, as I have long argued. However, banning smoking because city officials want to protect members of the public from having to see smokers is disturbing.

What's next? Is Berkeley going to ban fat people from business districts so that shoppers don't have to see the sight of the obese?

The Berkeley City Council states that the government has a responsibility to help people fix their lives. OK, I'll entertain that notion. But is smoking a problem that the government has to "fix" for people?

Sure, it makes sense for the city to provide social workers who can go around and offer services to homeless persons and try to help them obtain needed services and programs, and especially, housing.

But you don't go around approaching smokers and telling them that they need to rehabilitate themselves and fix their lives. You don't legislate that.

The impetus for the ordinance was that city officials were receiving complaints about rowdy behavior. How exactly is smoking "rowdy behavior?"

It really has the appearance that Berkeley public officials are trying to protect citizens from having to endure the sight of smokers.

I think I am now safe in opining that the anti-smoking movement has indeed gotten out of control.

Wednesday, March 26, 2008

Today, FORCES International has posted online what I expect will be the first of a series of roundtable interviews with me concerning issues of interest to smokers, smoker's rights advocates, and hopefully also to anti-smoking advocates, public health practitioners, and other members of the public at large.

This interview, conducted by FORCES' own Gian Turci, provides insights into my own experience with the tobacco control movement and my perspective on the McCarthyist nature of the movement. In addition to presenting my own story, it includes my perspective on issues such as the changes in the scientific integrity of the movement, the disallowance of any dissent in the movement to its established agenda and tactics, and the folly of the FDA tobacco legislation that is being overwhelmingly supported by almost all major anti-smoking groups.

The interview does include my revelation of some aspects of my own history with the tobacco control movement that I have not previously discussed on this blog.

FORCES introduces the initial interview as follows: "We are glad to present to our readers this new session of the FORCES Round Table. Gian Turci's guest this time is Michael Siegel. As most of our readers know, Siegel is a tobacco control advocate who has become, shall we say, the Aleksandr Solzhenitsyn of the movement. We don’t believe that the parallel is an exaggeration. As he discusses with the host, the tobacco control movement has degenerated into an ideology aimed to control behaviour and culture through demonization, censorship, discrimination and promotion of hatred and intolerance, and for which any means – truthful or not, moral or not – is legitimate to get rid of the smoker. Such ideologies do not tolerate the slightest dissent, and promise harsh punishments for those who dare."

I hope The Rest of the Story readers will enjoy listening to this interview.

I am very grateful to Gian Turci for his willingness to sit down and discuss these issues thoughtfully with me, despite our obvious difference of opinion on several aspects of tobacco control policy. I truly believe that it is only through thoughtful discussion and a willingness to hear the other side that we can work towards an effective approach to addressing problems such as this one. And of course, that goes for the tobacco control side as well (which is why I am committed to providing this forum to allow smokers' rights advocates and all interested members of the public to air their concerns, despite my strong views in support of workplace smoking bans).

Tuesday, March 25, 2008

On January 14, 2008, I reported that an anti-smoking group in Missouri - the Campus-Community Alliances for Smoke-Free Environments (CASE), run out of the University of Missouri in Columbia - claimed that 30 minutes of secondhand smoke exposure can cause atherosclerosis (hardening of the arteries) in nonsmokers.

At that time, CASE claimed: "The same half hour of secondhand smoke can cause atherosclerosis (hardening of the arteries) which leads to heart attacks and strokes."

Presumably in response to my post, CASE has retracted its assertion that 30 minutes of tobacco smoke exposure can cause atherosclerosis and has corrected it to now claim that short-term exposure leads to changes in blood chemistry that are precursors of atherosclerosis. Thus, it is now clearer that a single 30 minute exposure cannot itself cause hardening of the arteries. One would have to be regularly exposed to secondhand smoke for many years.

The corrected claim by CASE is as follows: "The same half hour of exposure to secondhand smoke can lead to changes in blood chemistry that are precursors to atherosclerosis (hardening of the arteries), which leads to heart attacks and strokes."

The Rest of the Story

This story demonstrates that my argument that more than 100 anti-smoking groups are making misleading claims about the acute cardiovascular effects of secondhand smoke is correct. CASE has essentially acknowledged that I was right and that its statement needed to be corrected. They did so. For that, I commend them.

Monday, March 24, 2008

In honor of March Madness, I am running my own tournament, complete with regions and brackets, to determine the anti-smoking organization champion for most ridiculous secondhand smoke health claim.

In order to be eligible for the tournament challenge, an anti-smoking group must be currently making a public claim about the health effects of secondhand smoke that is patently false on its face or else severely misleading. Currently making a claim means that the claim is present on the internet at the time of the start of the tournament and that it has not been retracted, corrected, or changed publicly and visibly.

Progression through the tournament will be determined by reader voting. The final winner will be announced on April 7, the same day that the NCAA college basketball tournament champion is crowned.

The tournament starts with the top 16 entrants for the most inaccurate health claim. Over the course of the next two weeks, we will whittle the field down to just one champion.

There are four regions: East, South, Midwest, and West. There are 4 anti-smoking groups per region. The first round consists of eight contests: two games per region. The winners of the two contests in each region face off to determine who will represent each region in the Final Four. Then the finalists in the East and South meet, as do the finalists in the Midwest and West.

Here are the regions and brackets:

EAST REGION

CONTEST 1

United States Surgeon General's Office (Washington, DC)

vs.Action on Smoking and Health (Washington, DC)

According to theUnited States Surgeon General's Office: "Even brief exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer."

According toAction on Smoking and Health: "Even for people without such respiratory conditions, breathing drifting tobacco smoke for even brief periods can be deadly. For example, the Centers for Disease Controls [CDC] has warned that breathing drifting tobacco smoke for as little as 30 minutes (less than the time one might be exposed outdoors on a beach, sitting on a park bench, listening to a concert in a park, etc.) can raise a nonsmoker'’s risk of suffering a fatal heart attack to that of a smoker."

CONTEST 2

Smoke Free Gwinnett Coalition (Lawrenceville, GA)

vs.St. Louis University Tobacco Prevention Center (St. Louis, MO)

According toSmoke Free Gwinnett: "Nonsmokers exposed to secondhand smoke for just 30 minutes experience hardening of the arteries."

According to theAmerican Cancer Society: "Immediate effects of secondhand smoke include cardiovascular problems such as damage to cell walls in the circulatory system, thickening of the blood and arteries, and arteriosclerosis (hardening of the arteries) or heart disease, increasing the chance of heart attack or stroke."

According to theLouisiana Public Health Institute: "Comparing the effects of active smoking and secondhand smoke, researchers found that chronic exposure to secondhand smoke is about 80% as harmful as smoking a pack of cigarettes per day."

CONTEST 2

Coalition for a Healthy and Responsible Tennessee (Nashville, TN)

vs.Audubon Area Community Services, Inc. (Owensboro, KY)

According to theCoalition for a Healthy and Responsible Tennessee: "The Journal of the American Medical Association reports that just 30 minutes of exposure to secondhand smoke changes blood chemistry and increases the risk of heart disease in non-smokers."

According toAudubon Area Community Services, Inc.: "As little as 30 minutes of secondhand smoke can lead to hardening of the arteries in nonsmokers, Japanese researchers reported at an American Heart Association (AHA) meeting in November."MIDWEST REGION

CONTEST 1

Smokefree Air for Everyone (Columbia, MO)

vs.Indiana University (Bloomington, IN)

According toSmokefree Air for Everyone: "After 20 minutes, blood platelets look like a pack-a-day smoker's, making your blood "sticky" and contributing to stroke causing blood clots."

According toIndiana University: "Exposure to second-hand smoke for just 30 minutes can rapidly increase a person's risk for heart attack, even if they have no risk factors. The smoke, which contains carbon monoxide, causes blood vessels to constrict and reduces the amount of oxygen that can be transported in the blood."

According toAmericans for Nonsmokers' Rights: "Just thirty minutes of exposure to secondhand smoke can cause heart damage similar to that of habitual smokers. Nonsmokers' heart arteries showed a reduced ability to dilate, diminishing the ability of the heart to get life-giving blood."CONTEST 2

Tobacco Free Coalitions of Clark County and Skamania County (Stevenson and Vancouver, WA)

According to theCity of Laredo, Texas: "After 120 minutes of breathing secondhand smoke, the risk of an irregular heartbeat (arrhythmia) that can itself be fatal or trigger a heart attack increases."

Anyone who wishes to challenge the qualification of an anti-smoking group listed above for the tournament is welcome to do so. In order to submit a challenge, you simply need to defend the statement being made by the group and provide some scientific evidence to support your contention that the statement is accurate and not severely misleading. So far, none of the anti-smoking groups have produced any evidence to support a claim of ineligibility of any of the above anti-smoking groups for this tournament. However, I am always open to scientific debate over the validity of these claims.

Results of these contests will be announced one round at a time, so please make your selections for the first round only at this time. The winners will be announced later and voting opened for the next round at that time.

Thursday, March 20, 2008

Would-be foster care parents of children under five years of age need not bother to volunteer if they are smokers, according to a new policy adopted in Sheffield, England.

According to an article in the Sheffield Star: "Foster carers who smoke have been banned from looking after children under five or disabled youngsters in Sheffield. The decision has been made following consultation between council officials and medical advisors – and other South Yorkshire councils are to follow suit. Authorities across the country are concerned about the potential health impact of passive smoking on children. ... Paul Makin, Sheffield Council's acting executive director of children and young people's services, said: ... 'The most recent and authoritative advice from British Association for Adoption and Fostering is that children under the age of five and disabled children shouldn't be placed with foster carers who smoke. This has been confirmed by our medical advisors. Therefore, we are not considering foster carer applications for this age group from smokers or those who have given up smoking within the last year.'"

Other communities in the area seem ready to follow suit. Barnsley is considering adopting the same policy.

According to the Sheffield City Council web site, you cannot foster a child under five if you smoke. However, you can foster if you are a convicted criminal, as long as the offense doesn't involve the abuse of children or something similarly serious. Sheffield desperately wants and needs foster parents and emphasizes that they take nearly all comers, as long as you don't smoke:

"You CAN foster whether you’re single, married or a non-married couple. If you’re gay or straight, unemployed, working or retired. As long as you’re over 21 there are no age restrictions, providing you’re fit and able to care for a child. We welcome people from all religious backgrounds, ethnic minority groups and people with disabilities. Plus we don’t mind whether you have children of your own or not, or if you live in rented accommodation or have your own home."

"The reason we are so open is because what matters most to a child is who you are as a person, your character and capacity to care. So you need to be able to empathise with children who are going through a tough time. Be sympathetic and caring even when a child is being difficult and more importantly have a good sense of humour."

While Sheffield will not, under any circumstances, consider an application from a smoker, the city will entertain offers from convicted criminals: "People with criminal convictions or cautions can foster, much depends on the seriousness of the offence, how long ago it was, and how you have lived your life since."

The Rest of the Story

What Sheffield is saying here is that smokers are simply not fit to be parents. The city would rather take on a convicted criminal (as long as it's not a sexual violence or child abuse-related crime) than a smoker. The city proclaims to be "so open" because "what matters most to a child is who you are as a person, your character and capacity to care." But what seems to matter first and foremost is whether you smoke.

The city puts up very few categorical restrictions on foster parents. Even being a convicted criminal is not a categorical restriction. Your personal situation will be taken into account.

Not so if you are a smoker.

It is disgusting, to say the least, that smokers are categorically considered to be unfit parents. And it is even more disgusting that smokers are categorically considered to be unfit parents, while most convicted criminals are deemed worthy of full consideration. You can redeem yourself if you have been convicted of most crimes. But you can't redeem yourself if you are a smoker.

In fact, you can't even redeem yourself by quitting smoking. You have to wait a full year after quitting before your application to foster will even be considered.

In addition to being disgusting, the policy makes no sense. Why would the city want to categorically deny itself the fostering services of 30% to 50% of its population, without even interviewing these individuals? Why deny such a large group of people the opportunity to foster, when it is undeniably true that many of those denied individuals will be the best possible foster parents?

If Sheffield is so concerned about even the possibility of secondhand smoke exposure, then why allow parents to foster if they take those children to places that allow smoking? Does the city screen for parents who take their children to places that are smoky? Do they eliminate from consideration people who have friends who smoke? What if the foster grandparents smoke?

What about parents who take their kids out all the time for fast food? How about parents who allow their children to watch television and play video games all day long?

To be sure, there are a host of considerations that go into the decision about whether to allow a person to foster. But with very few exceptions, these considerations are made on a case-by-case basis. An individual is examined as a whole. There are few categorical exceptions, other than the obvious ones like being a child molester or abuser.

Not so any longer. Now you can add being a smoker to the list.

Importantly, most smokers who want to adopt or foster children agree not to smoke around their children. Just because an individual smokes doesn't mean that he or she will smoke around the child.

Furthermore, just because a person quit smoking within one year doesn't mean that he or she will resume smoking and that when he or she does resume smoking, he or she will smoke around the child.

To categorically deny foster parenthood to individuals who smoke without even considering whether they will actually expose the children to tobacco smoke or not is not only discriminatory, but it seems hateful.

I should add that there is generally a high demand for foster parents. It is not like there is a huge surplus supply sitting around and the state can eliminate 30% to 50% of the otherwise willing and able pool and still be able to provide homes for all children who need them. The policy will likely result in some children being denied foster home care. It also might result in some parents being allowed to foster who are much higher risks to the children than the excluded smokers would have been.

Almost invariably, a categorical exclusion of smokers is going to decrease the quality of the final foster parent pool. Ironically, the policy that is supposed to help protect children may, in the long run, end up doing some harm.

With this kind of hateful policy toward smokers, is it any surprise that a large proportion of smokers are becoming increasingly resistant to the idea of quitting?

Wednesday, March 19, 2008

Last week, an Illinois Senate Committee voted to approve a bill that would ban the sale of flavored cigarettes, except for menthol cigarettes.

According to a St. Louis Post-Dispatcharticle: "Rep. Jacqueline Collins, D-Chicago, said flavored cigarettes were most attractive to young people because they could be flavored like candy, fruit or soda, unlike regular cigarettes. Collins said the legislation gave the state an "opportunity to better protect children," saying that studies have proven that flavored cigarettes are more likely to be used by teens than by older adults. The ban would not extend to menthol cigarettes. A 2005 report from the American Lung Association, stated that 20.2 percent of 18- to 19-year-olds had tried flavored cigarettes, compared with 8.6 percent of 20- to 26-year-olds."

The Rest of the Story

The bill specifically eliminates the use of the following flavorings in cigarettes:

fruit

candy

chocolate

vanilla

honey

sugar

nut

mint

cocoa

dessert

soft drink

alcoholic beverage

herb

spice

However, the bill specifically allows the use of the following flavoring in cigarettes:

menthol

There are no data of which I am aware that any substantial proportion of youth smokers smoke flavored cigarettes.

In contrast, there are abundant data documenting that approximately 30% of youth smokers smoke menthol cigarettes. Among African-American youths, more than 70% smoke menthol cigarettes.

Thus, what the Illinois Senate committee has done is to make it look like they really care about the youth smoking problem by passing a law that garners news headlines, but not to actually do anything meaningful about the problem. The bill does little, if anything, to reduce youth smoking because it targets a wide range of flavors that are almost never used in cigarettes but ignores the chief flavoring that is actually used in cigarettes and which attracts a large proportion of youths, and the overwhelming majority of African-American youth smokers.

I'm not arguing that menthol cigarettes should be banned. I am arguing that legislators in Illinois are talking the talk, but they're not walking the walk.

If they are truly concerned about reducing youth smoking, and they truly believed that regulating the content of cigarettes sold in the state was an appropriate intervention, they there is no excuse for these legislators not voting to prohibit the sale of menthol cigarettes in Illinois. Otherwise, they are little other than hypocritical politicians.

This is an all-too-common ploy that I have seen increasingly over the past few months: gain political points by making it look like you are really doing something to address the tobacco problem but don't actually deal with the problem in any substantial way. That way, you get the best of both worlds: political gain without having to actually exhibit courage or integrity.

Illinois Senate Bill 2825 is not about public health. It's all about politics.

Tuesday, March 18, 2008

Despite a publicly-released Form 990 by FORCES as well as Americans for Nonsmokers' Rights' (ANR) own admission that they have no evidence that the group is funded by the tobacco industry, ANR continues to claim that FORCES is a tobacco industry front group and ally and to imply that the group is secretly funded by the tobacco companies.

In the introduction to its "Front Groups and Allies" section, ANR explains that: "It has been a common practice of Big Tobacco to use third parties or to create front groups "to be out in front fighting" smokefree policies, while the industry remains behind the scenes, protecting its public image. ...Since 1994, Philip Morris and other tobacco companies have partnered with national and state restaurant associations, licensed beverage associations, and gambling associations as key third parties to publicly oppose smokefree ordinances. ... Advocates should shine the light on these associations and connections to the tobacco industry. See our factsheet on how to follow the money to find industry connections in your community. There isn't always a "smoking gun" linking the tobacco industry to these groups, either due to lax local campaign finance laws, or money getting funneled through third parties. Often we don't find out until years later that the tobacco industry was funding opposition activities. In any case, showing that suspicious groups are pulling out all the familiar tricks will encourage people to take the Big Tobacco message delivered by these groups with a grain of salt."

Then, ANR lists FORCES as one of these front groups and allies. However, ANR admits that it is aware of evidence that FORCES was not funded by the tobacco industry: "a 1999 Philip Morris (PM) memo indicated that FORCES did not accept tobacco industry funding. Nevertheless, ANR states: "For more information about the strategies behind smokers' rights groups, please read The National Smokers' Alliance Exposed. Even though the National Smokers' Alliance is now (sort of) defunct, the background information from this document is still relevant to other smokers' rights groups such as FORCES."

The document ANR refers to describes how the tobacco industry created and funded the National Smokers' Alliance as an industry front group. Thus, ANR's statement implies that FORCES is also a tobacco industry front group, created by and funded by the industry.

FORCES' multiple appearances in the tobacco industry database again suggest that ANR is insinuating that FORCES is a tobacco industry front group.

The Form 990 submitted by FORCES in 2005 reveals that its 2004 contributions amounted to only $11,498. This is hardly evidence of funding by Big Tobacco. If the tobacco companies wanted to fund a front group to do their bidding behind the scenes, I think they could afford to contribute a little more than just $10,000 or so.

According to ANR, the true tobacco industry front group - the National Smokers' Alliance - was funded by the industry to the tune of over $4 million. It should be quite obvious to ANR that was is going on with FORCES is something completely different. How ANR can state that "the background information from this document [concerning Big Tobacco's funding of the National Smokers' Alliance] is still relevant to other smokers' rights groups such as FORCES" is beyond me.

But ANR doesn't seem concerned about being able to prove its accusations of wrongdoing. To ANR, it appears enough to simply think that a smoker's rights group might be funded by the tobacco companies. That's apparently enough to make a public accusation, and ANR advises local tobacco control groups to do just that: "showing that suspicious groups are pulling out all the familiar tricks will encourage people to take the Big Tobacco message delivered by these groups with a grain of salt."

In other words, what ANR appears to be saying is that you don't need to have evidence that FORCES or another smokers' rights group is a Big Tobacco front group. Just make the accusation or insinuation anyway and you can discredit the group. Often, there is no smoking gun and we don't find out until years later that the group was funded by the industry. So don't let that stop you. Go ahead and make the accusation now, without evidence. After all, you might end up being right. But it doesn't really matter because your goal is to discredit the enemy, not to worry about the facts, the evidence, or the truth.

The Rest of the Story

The truth is that despite what ANR would like to believe, FORCES is not a tobacco industry front group or even an industry ally. It was not created by the industry, it is not funded by the industry, and it is not part of an alliance with the industry. In fact, FORCES has been an outspoken critic of Big Tobacco and would like nothing more than to have the big companies crumble (lower cigarette prices would be of financial benefit to smokers).

The truth is that FORCES is an organization that is working to achieve its own goals. It is made up of members who sincerely believe in what they are working towards. They are not doing the tobacco industry's bidding; they are not serving as a secret front group.

While ANR might not like to admit it, there are citizens out there who do not support the tobacco control agenda, and the reason they do not support that agenda has nothing to do with being paid by or used by or allied with the tobacco companies. It is undoubtably true that there are also some groups out there which are tobacco industry front groups and allies. And it is important for tobacco control groups to point out or expose those particular groups. But to accuse all opposition groups of being front groups or allies, without evidence to support those accusations, is not appropriate.

The rest of the story is that ANR has descended to an unethical level. It is using unethical and inappropriate tactics in its fight against the tobacco industry. It is making false claims and undocumented assertions and accusations to the public in order to support its agenda. While I personally support most aspects of that agenda, I do not condone the use of these unethical tactics.

If ANR has evidence that FORCES is funded by the tobacco companies and/or is part of an alliance with the industry, it should put forward that evidence immediately. If not, then it should immediately retract or clarify its false accusation.

Monday, March 17, 2008

The supporters of FDA tobacco legislation have finally admitted that what I and a number of other tobacco control advocates have been saying about the proposed legislation currently before Congress is true: the bill is severely flawed because it would harm the public's health by undermining public health messages about the dangers of cigarettes, thus leading to increased smoking and adverse health consequences.

In my statement submitted to the Senate Health, Education, Labor, & Pensions Committee, I testified that: "By giving tobacco products an FDA stamp of approval, the legislation will undermine the public’s appreciation of the dangers of cigarettes, but without actually ensuring that these products are significantly safer. ... It will reduce the public's perception of the inherent harms of cigarettes. By promulgating health standards, FDA will be giving the public the perception that cigarettes are now safer to smoke. The public is not necessarily aware of the 4,000 toxins and 50+ carcinogens in the smoke, nor are they epidemiologists - if they are told that the nitrosamines have been removed, they are naturally going to perceive that the problem is being taken care of, or at least largely taken care of. Since we know that smoking prevalence is directly proportional to the degree of perceived harm from smoking, this will lead to an increase in smoking prevalence (at least compared to what would have occurred in the absence of the legislation)."

Apparently in acknowledgment of this point, the supporters of the FDA legislation have added a new provision to the legislation, prefaced by the following statement of principle: "If manufacturers are permitted to state or imply in communications directed to consumers that a tobacco product is approved or inspected by the Food and Drug Administration or complies with Food and Drug Administration standards, consumers are likely to be confused and misled. Such a statement could result in consumers being misled into believing that the product is endorsed by the Food and Drug Administration for use or in consumers being misled about the harmfulness of the product because of such regulation, inspection, approval or compliance."

Because of this problem, the FDA legislation would essentially result in the transfer of fraud that in the past was committed by tobacco companies over to the federal government. Previously, it was the tobacco companies that were falsely implying that their products were somehow safer because of product design changes such as reduced tar and nicotine levels (the companies were found guilty of racketeering largely because of this). Now, under the FDA legislation, the bill's supporters readily admit that it will be the federal government which is misleading consumers into believing that the product is safer, when in fact there is no documentation that it is. In other words, it is now the government that will be committing fraud, instead of the tobacco companies.

Not only do FDA legislation supporters now readily admit that this is what the bill does; they feel so strongly about the unacceptability of these perverse consequences that they have amended the bill so as to legally prevent the companies from publicly stating that the FDA has approved cigarettes, or even that the FDA regulates cigarettes or that a tobacco company is complying with the FDA regulations regarding their products.

The added provision to the legislation precludes the tobacco companies from making: "any statement directed to consumers through the media or through label, labeling, or advertising that would reasonably be expected to result in consumers believing that the product is regulated, inspected, or approved by the Food and Drug Administration, or that the product complies with the requirements of the Food and Drug Administration, including a statement or implication in the label, labeling, or advertising of such a product, that could result in consumers believing that the product is endorsed for use by the Food and Drug Administration or in consumers being misled about the harmfulness of the product because of such regulation, inspection, approval, or compliance."

The Rest of the Story

It's heartening to know that both supporters and opponents of the FDA tobacco legislation within the tobacco control community are now on the same page as far as its harmful effects on the public's health, due to the implied safety of cigarettes that consumers will perceive due to this regulatory scheme and as far as the unacceptable and perverse effect that the legislation will have in terms of the transferring of fraud from the tobacco companies to the federal government.

What remains boggling, however, is why the supporters of this legislation would continue to support it, given that they acknowledge these perverse and detrimental effects.

If the supporters believe that by precluding the tobacco companies from communicating to the public that cigarettes are regulated by FDA, they will be able to prevent the public from finding out about the legislation, they are deceiving themselves. Communications from tobacco companies are not the only way that the public obtains information. There are also newspapers, television stations, radio stations, and the internet. Surely the public is going to become aware that cigarettes are under the regulatory jurisdiction of the FDA, even if the cigarette companies are prohibited from telling the public.

Thus, the fix that bill supporters have proposed is an ineffective one. If they are truly concerned that the public is going to be misled about the safety of cigarettes by finding out that the product is "regulated" by the FDA or that cigarette companies are complying with FDA regulations on tobacco products, as the legislation states, then there is simply no way to prevent that from happening. You just can't stop the public from finding out that this bill passes, if it does. The media are going to cover this issue heavily and the public is going to find out that cigarettes have been placed under the regulatory jurisdiction of the FDA.

The fact that bill supporters felt the need to insert a clause stating that tobacco companies cannot tell the truth about their products - and must hide the fact that the FDA regulates cigarettes and that these companies comply with those regulations - demonstrates how weak this legislation really is.

If you need to hide from the public the fact that the FDA regulates cigarettes because it is going to undermine their appreciation of the hazards of cigarettes, then perhaps FDA regulation of cigarettes is not such a good idea in the first place. And if you have to force cigarette companies to hide the truth from their consumers in order to avoid perverse consequences from your regulatory scheme, then perhaps you need to go back to the drawing board.

To make matters worse, the fix provision that bill supporters have inserted is clearly unconstitutional, as it violates the free speech rights of the tobacco companies.

How can you infringe upon the free speech right of tobacco companies to simply tell their consumers the truth about the regulatory status of their products?

It would be one thing if the legislation precluded the companies from misleadingly implying that because of FDA regulation of cigarettes, the product is now safer. However, that's not what the legislation does. It imposes an outright ban on cigarette companies merely stating the simple truth that the FDA has regulatory authority over cigarettes. It bans the simple, materially truthful statement that a tobacco company is in compliance with FDA regulations.

Can you imagine a similar ban on any other company? Suppose that Congress passed a bill that did not allow the manufacturers of pharmaceuticals from informing the public that their products are regulated by the FDA. That would clearly be viewed as an infringement of the pharmaceutical companies free speech rights. The same is true of the tobacco companies and their right to make materially truthful statements to the public.

This is especially true of statements for which there is no dispute about their deceptiveness. No one would or could dispute that the statement: "Tobacco products are now under the regulatory authority of the FDA" would be a truthful and non-deceptive statement should the legislation be enacted. Yet the legislation would prevent the tobacco companies from making such a statement.

In fact, the legislation would prevent a tobacco company from even stating: "Tobacco products are now under the limited regulatory authority of the FDA," or "Tobacco products are now under an extremely limited regulatory scheme by the FDA."

Furthermore, a tobacco company could not even report to consumers that the FDA legislation was enacted, since that would reasonably be expected to result in those consumers believing that the FDA regulates cigarettes. So if Philip Morris wants to report, on its website, that the FDA legislation was enacted, that would be precluded by this legislation.

This legislative provision clearly fails the 4th prong of the Central Hudson criteria for the regulation of commercial free speech because it is far more broad than is reasonably necessary to achieve the stated government purpose in regulating the speech. Here, the purpose is to prevent the deception of consumers, yet the legislation prevents telling the material, indisputable truth.

If you need to rely on an unconstitutional alteration to your legislation to prevent it from having detrimental effects on the public's health, I would suggest that a better approach would be to re-work your legislation so that it doesn't have such detrimental effects. Unfortunately, the health groups supporting the FDA legislation are committed to passing the bill in its present form, regardless of their own admission that it is going to mislead consumers - falsely - into believing that cigarettes are safer, and even though it is going to transfer the fraud previously committed by tobacco companies (for which we have attacked and convicted them) over to the federal government.

Friday, March 14, 2008

Welcome to the nominations and voting thread for The Rest of the Story's 2008 Anti-Smoking Hypocrisy Awards (see 2007 Awards here).

This year, we have nominations in two categories: individual and organization. This post will present the nominations for the individual award. A subsequent post will present the nominations for the organization award.INDIVIDUALAWARD NOMINEES1. Former New York Attorney General and Governor Eliot Spitzer

In his inauguration speech, Spitzer emphasized that his goal was to bring ethics back to Albany and that he was committed to rising to the moment and demonstrating his responsibility to the people of New York State:"I pledge to toil each and every day so as not to disappoint the hard working people of this state.""we must change the ethics of Albany"

"If ever there was a time that called out for introspection by those in government, it is now."

"those of us who work in the great building behind me must hear and heed the serious responsibility that public service demands and rise to this moment and show the public in words and in deeds that we understand that our responsibility is to the people of New York."

As Attorney General, Spitzer conducted several prostitution ring busts and spoke of his revulsion to prostitution.

The Rest of the Story

Federal investigators - using wiretap and other sources - have identified Spitzer as "Client 9," who met with a high-priced prostitute at a Washington hotel last month and has been spending tens of thousands of dollars for multiple trysts with prostitutes over the past six months.

According to the federal affadavit, as reported by the New York Times, Client 9 was a return customer who had engaged the services of Kristen - a 5 foot 5, 105 pound young woman - in his Mayflower Hotel room in Washington on the night of February 13, the evening before Spitzer testified before Congress regarding the bond insurance crisis.

According to the New York Times, Client 9 was described in the affadavit "as a 'difficult' man who sometimes asked the prostitutes 'to do things you might not think were safe.'"

Spitzer resigned from office on March 12, but failed to explicitly disclose his involvement with the prostitution ring and insisted that his transgressions were a "private" matter.

2. Former Friendship Heights Mayor Alfred Muller

Former Mayor Muller, a physician, sought to protect children in Friendship Heights (Maryland) from even the sight of a smoker. Thus, in 2000 he promoted - successfully - the enactment of the nation's toughest smoking ban, which prohibited smoking anywhere on village property, including parks, sidewalks, and lawns. Dr. Muller admitted that he was not only trying to protect nonsmokers from minute amounts of secondhand smoke, but also to protect children by establishing a new social norm.

The Rest of the Story

In May 2001, Dr. Muller was found guilty of molesting a boy in the bathroom at the Washington National Cathedral. He was sentenced to three years probation and was registered in Maryland as a sex offender.

3. Governor Christine Gregoire

Former Attorney General and current governor of Washington, Gregoire champions herself as a national leader in tobacco control and campaigned successfully for governor on that platform. She was a 1999 winner of the Good Housekeeping Award for Women in Government due to her role in "bringing the tobacco industry to its knees." She also won the 2004 Julius B. Richmond Award for her efforts in fighting the tobacco industry. As Attorney General of Washington State, Gregoire played a key role in the negotiation of the 1998 Master Settlement Agreement [MSA] between 46 states and the major tobacco companies. She is a former board chair of the American Legacy Foundation.

The Rest of the Story

In 2003, Gregoire along with other attorneys general intervened in an Illinois tobacco court case, submitting an amicus brief to a trial court judge urging him to reduce the $12 billion appeal bond he had ordered Philip Morris to pay, as specified by Illinois law, after the company was found guilty in a class-action lawsuit.

In intervening to protect the financial well-being of Philip Morris, Gregoire wrote: "Defendant Philip Morris has informed the States that the $12 billion appeal bond required in this Court’s March 21, 2003 Judgment may prevent it from making the $2.6 billion payment to the States that the MSA requires it to make on April 15, 2003. The States submit this brief to advise the Court that many State programs, including vital public health programs, depend on MSA payments for their support and to urge this Court, after a full assessment of Defendant’s financial condition, to exercise its discretion to set an appeal bond that does not interfere with the States’ vital interests. ... The States have a strong interest in preserving the value of the settlements they fought for and won, and the results in this lawsuit should not prejudice those settlements."

In other words, Gregoire was arguing that because the legal remedy awarded to plaintiffs in Illinois - under the judicial system and laws of Illinois and under the United States Constitution - affected financial payments to her state, the judge should alter the application of Illinois law to protect her state's financial interests, and that concern should override the pursuit of justice by these citizens under the laws of Illinois.

It is baffling how any serious or meaningful award in tobacco control could be given to a public official who went to bat for Philip Morris, intervening and interfering in the pursuit of justice by a class of citizens in another state, all in an effort to protect the financial welfare of the nation's leading tobacco company (whose products, based on market share, kill more than 200,000 Americans each year).

4. Senator Edward Kennedy

Senator Kennedy, who claims to be a Congressional leader in the fight against Big Tobacco, blasted the tobacco companies in January 2007, attacking them for trying to addict millions of new smokers in the United States. Referring to a Harvard study which claimed that the companies - including Philip Morris - were increasing their nicotine yields to addict smokers, Senator Kennedy stated:

“This study is an extraordinary public service by Harvard’s School of Public Health. It’s dramatic new proof that Big Tobacco is addicted to addicting millions of young smokers into lifetimes of illness and early death. Congress has been an accomplice in the travesty because of the success of the tobacco lobby in blocking real reform. Hopefully, the study will be a wake-up call to persuade Republicans and Democrats alike to enact long overdue legislation allowing the FDA to regulate cigarettes and deal with their enormous risks.”

The Rest of the Story

Behind the scenes, Senator Kennedy inserted language into the proposed FDA legislation that exempted clove from the list of banned flavorings in cigarettes. The original bill banned the use of clove as a primary flavoring in cigarettes. However, the bill that the Senate Health, Education, Labor, and Pensions Committee first saw exempted clove from the ban that affects all other flavorings (other than menthol, which was already exempted). Senator Kennedy was responsible for producing the Chairman's mark that the Committee considered.

Probably not coincidentally, Senator Kennedy's secret revision came at a perfect time for Philip Morris, which according to a New York Timesarticle, "recently introduced a clove-flavored version of its Marlboro brand in Indonesia. The company spent $5 billion in 2005 to buy a controlling stake in Sampoerna of Indonesia, a large maker of clove cigarettes."

Senator Kennedy's secret favor for Philip Morris was quickly discovered and eliminated from the bill, as the Committee voted to place the clove ban back in the bill before sending it out favorably.

Thursday, March 13, 2008

The 14th World Conference on Tobacco OR Health, which will be held in Mumbai, India in March 2009, will be sponsored by none other than two of the largest representatives of Big Pharma: Glaxo Smith Kline and Pfizer.

Pfizer is the manufacturer of Chantix (varenicline), which the company is heavily promoting as a smoking cessation aid, despite reports that the Food and Drug Administration is investigating numerous reports of suicidal ideation and other adverse psychiatric side effects in patients who took the drug.

In addition, Pfizer

is the manufacturer of Nicotrol, a nicotine patch being promoted by the company as a smoking cessation aid; and

apparently funds research on the use of chest CT screening to scare smokers into quitting smoking (and thus increasing the pool of potential nicotine patch users).

One of the chief topics to be discussed at the conference is tobacco cessation and strategies to promote it.

The Rest of the Story

In my view, the acceptance of pharmaceutical industry sponsorship by a conference which aims to objectively discuss science and objectively consider policy strategies to promote smoking cessation amounts to prostitution of the scientific integrity of the global tobacco control movement.

How can you objectively discuss the population impact of NRT (nicotine replacement therapy) use at a conference sponsored by two of the leading nicotine replacement therapy drug companies?

How can you objectively discuss effective national strategies for smoking cessation at a conference sponsored by two of the leading nicotine replacement therapy drug companies?

How can you objectively discuss tobacco product regulation (which has major implications for the way in which nicotine replacement therapy products are marketed) at a conference sponsored by two of the leading nicotine replacement therapy drug companies?

How can you objectively discuss all aspects of individual and population-based approaches to helping people quit smoking at a conference sponsored by two of the leading nicotine replacement therapy drug companies?

The answer, in my opinion, is that you can't.

You can't objectively discuss the appropriate role, if any, of nicotine replacement products in a global smoking cessation strategy when the very conference you are attending is being sponsored by perhaps the two leading companies that have a great financial interest in the results of that discussion.

So the upshot is that the World Conference on Tobacco or Health cannot and will not offer an objective consideration of the potential role of nicotine replacement products in a national and global smoking cessation strategy.

The practice of tobacco control in the United States has already been prostituted by allowing the Chair and several members of the national advisory panel on smoking cessation strategies to serve on the panel despite their significant financial conflicts of interest with Big Pharma (see: post 1; post 2; post 3; post 4).

To prostitute oneself is defined as "selling one's abilities, talent, or name for an unworthy purpose." By accepting Big Pharma money in order to fund its symposium, the World Conference on Tobacco OR Health, in my opinion, is selling its name for what I consider to be an unworthy purpose. The Conference is allowing itself to be used as a pharmaceutical marketing agent, simply to make money, when the over-reliance on pharmaceutical agents is in my opinion one of the main reasons why smoking cessation efforts and policies have been so ineffective.

The preoccupation with nicotine replacement therapy, spurred on by the infusion of pharmaceutical dollars into the tobacco control field, is causing us to lose sight of the actual root of the problem: the addictive state itself. And that is a shame, because it may be severely hampering our efforts to help smokers quit.

The benefits and importance of drugs in the smoking cessation process have been over-emphasized, and I urge readers to read extensively on the web site of John Polito, who I find has the most insightful understanding of the smoking cessation process and the potential role of NRT products as anyone I know in the tobacco control field.

In my view, the acceptance of Big Pharma money to fund a tobacco control conference at which smoking cessation strategy is going to be discussed is not just a private matter. It represents a disservice to the public who we in tobacco control are supposed to serve.

Wednesday, March 12, 2008

An article in Monday's Delaware News Journal highlights the growing trend of employer intrusion into the private, lawful, off-the-job behavior of employees, especially in the area of smoking behavior.

According to the article: "It's no secret that lifestyle choices can cost people their health, and maybe even their life. These days, bad habits can also cost you your job. As U.S. companies scramble to contain health insurance costs and survive a wheezing economy, some are scrutinizing their employees' off-duty behavior, firing those who smoke, tacking surcharges onto overweight workers' health plans and even dismissing people for having an off-duty drink. Such practices are raising claims of unwarranted intrusion, a few cries of illegal discrimination and warnings of fraying liberties." ...

"If companies are justified in firing smokers, then logic would seem to open the door to banning all sorts of risky behaviors, from eating fatty foods to motorcycle riding. And conditions such as high blood pressure and high cholesterol could become bars to employment."

"'The same logic that goes into not hiring smokers is the same logic that could go into not hiring fat people, or not hiring people who eat steak,' said Michael Siegel, associate chairman of the Social & Behavioral Sciences Department at Boston University." ...

"Eventually, the need to rein in costs might become so pressing that 'we can all kiss our private lives goodbye,' the head of the National Workrights Institute told '60 Minutes.'" ...

"Aside from the occasional oddity -- one worker was fired for a bumper sticker that backed the "wrong" candidate, and a Coors employee in Colorado was canned when his boss caught him sipping a Budweiser -- employers mainly are targeting smokers. In part, society's crusade against smoking has made smokers politically "safe" to persecute, Siegel said." ...

"Critics recognize the dilemma companies face, but believe the financial well-being of a corporation should not prevail over personal freedom and contend that using smoking as a criterion for dismissal will inevitably lead to greater intrusions. 'Do we really want to deny the ability of a person who smokes to make a living?' asked Drewry Nash Fennell, director of the Delaware ACLU. 'At what point do we say that an employer has gone too far in regulating health consequences? Do you have to give up skiing, rock climbing?'" ...

"in any case, companies clearly are acting with more concern for profit than health, some say. 'I have to question their sincerity' in claiming to have pure motives, Siegel said. 'If they were truly sincere about hiring a healthy work force ... why are they still hiring obese people?'"

The Rest of the Story

I'm glad that reporters are now able to turn to someone within public health who is dedicated to the anti-smoking cause (i.e., an "anti") to get a quote expressing concerns about employer discrimination against smokers. I'm afraid that outside of The Rest of the Story, there is little public opposition to this type of undue intrusion into employee privacy from within the tobacco control field (at least in the United States - Dr. Simon Chapman in Australia has also been outspoken about this issue).

It it striking that despite their purported concern about spiraling health care costs, employers are singularly concerned about smoking behavior. To me, that signals a hidden factor which is driving these policies: hatred for, or disapproval of smokers. The employment discrimination hasn't (yet) included obese people because I don't think there is the same level of hatred and disapproval.

In addition, I do believe that smokers are now politically safe to discriminate against, while groups such as obese people are not. This is why employers are focusing narrowly on smokers when they decide to use discrimination as a tool to save money.

About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.